Access to Quality MH Care Does Not Equate to Use by Black Immigrants

Immigration history and status remain fundamental elements of black immigrants’ sense of belonging and perceived experiences with discrimination, marginalization, threats to family, education, employment, and health care services. Access to high-quality and affordable care does not equate with use of that care despite the need for it. Many individuals are afraid to seek out care or fully engage with treatment due to their concern that it might impact their immigration status. This fear pervades throughout the African diaspora, touching individuals who are permanent residents, temporary residents (students, professionals), and humanitarian migrants (refugees), to name a few.

I remember Nugo, from Nigeria, who required psychiatric hospitalization for an acute decompensation. While he was grateful that his condition improved, he was frightened that “this type of incident” would interfere with the renewal of his student visa, and as a result, he firmly declined any future care. With the stress of trying to create a new life and assimilate into a new culture, Nugo had an entrenched fear that if he did not play by the rules and “be mentally well,” his visa might be in jeopardy.

To what extent does immigration history and status deter black immigrants from appropriately using health care services? This is the issue I brought to the 48th Annual Legislative Conference last month in Washington, D.C., Organized by the Congressional Black Caucus Foundation (Psychiatric News. It was sponsored by Rep. Daniel K. Davis (D-Ill.), who has a long interest in the health and well-being of black immigrant families. I joined a panel of black leaders and advocates.

Having a front-row seat in the black immigrant community to learn their strengths, cultural traditions, and cumulative local experiences, I found this opportunity was timely to increase awareness, educate the public, and inform policy on the deterrent effect of immigration issues on mental health service use. It also created momentum to recognize and amplify existing endeavors and accomplishments in the field of psychiatry aimed at addressing immigrant issues through expanding cultural competency training, which improves the effectiveness of psychiatric treatment for immigrant and ethnic minority patients—building a culture of diversity, equity, and inclusion, which has multiplicative effects on the workforce, the people we train, and the communities we serve; and advocating for better health insurance coverage, which promotes equitable access to care.

While psychiatry has become increasingly sophisticated in its approach to culturally sensitive care and stigma reduction, we still have a long way to go to create systems that are welcoming to fully engage those who are in need of our services but are afraid to seek help.

At the clinician level, we need to explore not only immigrant patients’ symptoms, but also their narratives around immigration issues. Building and maintaining trust while assuring them of confidentiality remain central to this rewarding effort.  ■